103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024
SB1422

 

Introduced 2/7/2023, by Sen. Patrick J. Joyce

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/370g  from Ch. 73, par. 982g
215 ILCS 5/370u new

    Amends the Illinois Insurance Code. Provides that if the policies, agreements, or arrangements of an insurer operate unreasonably in restricting an insured individual's ability to obtain home medical equipment, then an insurer is required to reasonably reimburse its insured for expenses incurred due to the unreasonable restriction. Defines "arrangement".


LRB103 27645 BMS 54021 b

 

 

A BILL FOR

 

SB1422LRB103 27645 BMS 54021 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 370g and by adding Section 370u as follows:
 
6    (215 ILCS 5/370g)  (from Ch. 73, par. 982g)
7    Sec. 370g. Definitions. As used in this Article, the
8following definitions apply:
9    (a) "Health care services" means health care services or
10products rendered or sold by a provider within the scope of the
11provider's license or legal authorization. The term includes,
12but is not limited to, hospital, medical, surgical, dental,
13vision and pharmaceutical services or products.
14    (b) "Insurer" means an insurance company or a health
15service corporation authorized in this State to issue policies
16or subscriber contracts which reimburse for expenses of health
17care services.
18    (c) "Insured" means an individual entitled to
19reimbursement for expenses of health care services under a
20policy or subscriber contract issued or administered by an
21insurer.
22    (d) "Provider" means an individual or entity duly licensed
23or legally authorized to provide health care services.

 

 

SB1422- 2 -LRB103 27645 BMS 54021 b

1    (e) "Noninstitutional provider" means any person licensed
2under the Medical Practice Act of 1987, as now or hereafter
3amended.
4    (f) "Beneficiary" means an individual entitled to
5reimbursement for expenses of or the discount of provider fees
6for health care services under a program where the beneficiary
7has an incentive to utilize the services of a provider which
8has entered into an agreement or arrangement with an
9administrator.
10    (g) "Administrator" means any person, partnership or
11corporation, other than an insurer or health maintenance
12organization holding a certificate of authority under the
13"Health Maintenance Organization Act", as now or hereafter
14amended, that arranges, contracts with, or administers
15contracts with a provider whereby beneficiaries are provided
16an incentive to use the services of such provider.
17    (h) "Emergency medical condition" has the meaning given to
18that term in Section 10 of the Managed Care Reform and Patient
19Rights Act.
20    (i) "Arrangement" means a scheme between insurers and
21health care service providers to supply health care products,
22including, but not limited to, a provider's maintenance of
23supplies to adequately fulfill its obligations under the
24scheme.
25(Source: P.A. 102-409, eff. 1-1-22.)
 

 

 

SB1422- 3 -LRB103 27645 BMS 54021 b

1    (215 ILCS 5/370u new)
2    Sec. 370u. Reimbursement; home medical equipment. If the
3policies, agreements, or arrangements of an insurer operate
4unreasonably in restricting an insured individual's ability to
5obtain home medical equipment, as defined in Section 10 of the
6Home Medical Equipment and Services Provider License Act, then
7the insurer is required to reasonably reimburse its insured
8for expenses incurred due to the unreasonable restriction.